I condemn the third year of medical school

[The Angriest Bird]

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1. If you just give me a book and tell me to R&M (read and memorize) instead of staying in the hospital, I can learn the exactly same knowledge of three rotations in the time of one

2. "No matter what specialty you go into you need to know ____" is the biggest bullsh*t delivered to med student. A pathologist does not need to know delivering babies. Trying to make a connection between any two fields in medicine is abusing the creative mind of human being and unethical.

3. I can't say "you learn from your patient" is wrong. But 99% of the patients I've seen offer nothing more than a vignette in some textbook.

4 Our education system is so ineffective because we use perhaps 1% of what we've been taught since childhood. It is okay before med school because at least it contributes to "intellectual enlightment" (or does it). When I'm 27 and 2 years from doing what I need to do for life (residency), I demand to "show me the where the beef is."

5. We all know grading is subjective, so that's no news. What's even worse is that I've been transformed from a knowledge-hungry med student to a emotion-sensitive business-like ass-sucking hypocrit. It's all about whether they like you. If my intern likes a particular TV show, I will watch that TV show instead of studying. And that has served me pretty well.

6. I'm actually becoming more and more like a jerk. I'm consciously defending it from happening, but I wonder when this shield will fail. My undermind is asking myself when I will be an attending so I'm entitled to do whatever I want. My passion for the patients is definitely fading away because most people I work with treat the disease but not the person. And everyone makes fun of patients right after they see them.

7. Calls are pointless. Tell me what you can learn from calls ONLY. They serve these purposes 1) making the hospital look more manned than it really is 2) making the residents feel better because they have co-surferers 3) tiring you out so you know what residency is like. Well I know residency suck like bloody ****, and if I have to go thru that crap anyway in 2 years, why let me go thru it now when I don't have to?

8. I actually support shelf exams. Without them 3rd year will be a complete waste of time. However, I really wish the clinical time helps it. It doesn't. The extreme case is surgery. 6 operations a day + 50 pimp questions won't get me a single point on the shelf because it's all medicine and surgeons ignore medicines (they never carry stethoscopes).

9. Trying to look enthuistic while you absolutely don't give a f*ck about what they are doing is the most hypocritical thing I've ever done in my life. Watching another person writing a note and looking like "OMG I JUST LEARN HOW TO WRITE A NOTE THANK YOU!!!" is so superficial but everyone is doing.

10. 9 out of 10 things you did in third year will be no more than "I did blah blah in my blah blah rotation" 15 years later. 9 out of things you've learned from studying will not retain 15 years later. 9 out of 10 comments you received on your eval won't help you become a better person, because jerks will stay jerks; it's genetic.

END: If this sounds like a pathetic venting thread, it perhaps is. You can call me a whiner; I totally won't mind. However, I ask you to spare 3 seconds on thinking about the message behind all these crap I mentioned:

Is third-year of med school really the best way to deliver medical education for everyone?

 

[lol.psych]

4 Our education system is so ineffective because we use perhaps 1% of what we've been taught since childhood.

For you, that 1% obviously does not include spelling or grammar.


I know I'm nitpicking/being anal. You don't have to tell me.

 

[WDeagle]

For you, that 1% obviously does not include spelling or grammar.


I know I'm nitpicking/being anal. You don't have to tell me.

Nothing is more annoying when people complain about little grammer errors. If you can understand what someone is saying then it doesnt matter. Everyone makes grammer mistakes.

 

[WellWornLad]

Nothing is more annoying when people complain about little grammer errors. If you can understand what someone is saying then it doesnt matter. Everyone makes grammer mistakes.

That's "grammar" mistakes. I don't find them annoying, but on an online forum such as SDN, such mistakes do tell you a lot about the person posting.

 

[Pinkertinkle]

Mostly agree. I long ago gave up hope of third year being anything useful other than a necessary hurdle. If you go in with low expectations, things aren't so bad eh?

Oh and please stop it with the grammar nazism, that was a very well written post compared to some of the stuff that gets in here.

 

[Kedan]

I think you're being narrow-minded. I mean, as long as we're condemning why not throw in all of pre-clin too. It's not like those were the best years of our lives.

 

[Bcblazer]

And everyone makes fun of patients right after they see them.

I'll disregard all else in the post and reply to this. Before I had much hospital exposure, hearing about such activity was to me one of the most worrisome things concerning medical training. After doing a considerable amount of shadowing and spending time with medical students and residents, I have come to understand why it happens, and am no longer shocked when I hear it in context. It almost seems normal, not because I've become desensitized to it, and despite otherwise nice, compassionate people taking part in it.

This is not to say that I condone making fun of patients, especially when it is malicious in nature. However, I can empathize with those who do it.

 

[Forthegood]

For you, that 1% obviously does not include spelling or grammar.


I know I'm nitpicking/being anal. You don't have to tell me.

Then don't post. It is annoying.

OP- what would you propose as a more effective means of education?

 

[Cp22kjer]

That's "grammar" mistakes. I don't find them annoying, but on an online forum such as SDN, such mistakes do tell you a lot about the person posting.

Do they really? I mean its just an online forum for godsake......

 

[rachmoninov3]

Too bad we can't all be as intelligent as the O.P. and just learn everything from books. I still have to think back to the first ARF patient I saw in a 3rd degree block with the high potassium to remember K/H relationships.

Yeah, 3rd year may be a lot of scut, but it might actually be worth if for some of us lowly mortal medical students who can't just memorize everything.

 

[Kedan]

Ok so I'm bored tonight (i.e. procrastinating) so I'm going to play Devil's advocate and try to do a point by point rebuttal.

1. If you just give me a book and tell me to R&M (read and memorize) instead of staying in the hospital, I can learn the exactly same knowledge of three rotations in the time of one

Sure you'd have the knowledge but there's more to medicine than that. You need to learn clinical skills like history taking and examination. That's why we come to the hospital, it's an apprenticeship.

2. "No matter what specialty you go into you need to know ____" is the biggest bullsh*t delivered to med student. A pathologist does not need to know delivering babies. Trying to make a connection between any two fields in medicine is abusing the creative mind of human being and unethical.

What if that pathologist was walking by when a lady goes into labour and ends up saving her and the baby? Ok so it's a stretch but delivery is my Kryptonite. I can't think of any good reason why anyone in this world should care about that, you know unless you're like an O&G specialist.

3. I can't say "you learn from your patient" is wrong. But 99% of the patients I've seen offer nothing more than a vignette in some textbook.

See my reply to 1 above. You can't examine a vignette.

4 Our education system is so ineffective because we use perhaps 1% of what we've been taught since childhood. It is okay before med school because at least it contributes to "intellectual enlightment" (or does it). When I'm 27 and 2 years from doing what I need to do for life (residency), I demand to "show me the where the beef is."

The problem with medicine is that most of what we learn is not required for our everyday job. Most of it pertains to the what if situation that may or may not pop up ever in our lives, just like the pathologist and the lady above or the drooling kid with epiglottitis that most of will never see but everyone will know to intubate the second he steps into the ED. Of course saving even one life is important so we have to learn that stuff. (Sidebar: This is probably why people think nurses can take over primary care)

5. We all know grading is subjective, so that's no news. What's even worse is that I've been transformed from a knowledge-hungry med student to a emotion-sensitive business-like ass-sucking hypocrit. It's all about whether they like you. If my intern likes a particular TV show, I will watch that TV show instead of studying. And that has served me pretty well.

Um...well, isn't this really your choice. Nobody is forcing you to be this way, you made that decision because it "has served me pretty well", which is fine, but I assure you many medical students have managed to get through 3rd year without turning into "a emotion-sensitive business-like ass-sucking hypocrit."

6. I'm actually becoming more and more like a jerk. I'm consciously defending it from happening, but I wonder when this shield will fail. My undermind is asking myself when I will be an attending so I'm entitled to do whatever I want. My passion for the patients is definitely fading away because most people I work with treat the disease but not the person. And everyone makes fun of patients right after they see them.

See 5 above.

7. Calls are pointless. Tell me what you can learn from calls ONLY. They serve these purposes 1) making the hospital look more manned than it really is 2) making the residents feel better because they have co-surferers 3) tiring you out so you know what residency is like. Well I know residency suck like bloody ****, and if I have to go thru that crap anyway in 2 years, why let me go thru it now when I don't have to?

Well it's an apprenticeship so you have to do everything that the job entails.

8. I actually support shelf exams. Without them 3rd year will be a complete waste of time. However, I really wish the clinical time helps it. It doesn't. The extreme case is surgery. 6 operations a day + 50 pimp questions won't get me a single point on the shelf because it's all medicine and surgeons ignore medicines (they never carry stethoscopes).

Well I could make the point that the exam is badly written. Surgery exams should test surgery knowledge (which I'm guessing made up the 50 pimp questions) not medicine. If after doing a rotation you can't pass the exam then the exam is testing the wrong thing. Besides, the point of 3rd year is the clinical training, to teach you how to be a doctor. A paper-based exam is a horrible way to assess clinical skills that's why they created OSCE's.

9. Trying to look enthuistic while you absolutely don't give a f*ck about what they are doing is the most hypocritical thing I've ever done in my life. Watching another person writing a note and looking like "OMG I JUST LEARN HOW TO WRITE A NOTE THANK YOU!!!" is so superficial but everyone is doing.

Again see 5 above.

10. 9 out of 10 things you did in third year will be no more than "I did blah blah in my blah blah rotation" 15 years later. 9 out of things you've learned from studying will not retain 15 years later. 9 out of 10 comments you received on your eval won't help you become a better person, because jerks will stay jerks; it's genetic.

Well, 9 out of 10 things you complain about now you'll forget in 15 years.

Ok so it's not the most impassioned defense ever but it's the middle of the night and I was mostly on your side to begin with.

 

[Law2Doc]

...
3. I can't say "you learn from your patient" is wrong. But 99% of the patients I've seen offer nothing more than a vignette in some textbook.

4 Our education system is so ineffective because we use perhaps 1% of what we've been taught since childhood. It is okay before med school because at least it contributes to "intellectual enlightment" (or does it). When I'm 27 and 2 years from doing what I need to do for life (residency), I demand to "show me the where the beef is."
...

10. 9 out of 10 things you did in third year will be no more than "I did blah blah in my blah blah rotation" 15 years later. 9 out of things you've learned from studying will not retain 15 years later. 9 out of 10 comments you received on your eval won't help you become a better person, because jerks will stay jerks; it's genetic.
...

I agree with you on the issues of subjective grading being less than ideal in the wrong hands (ie jerks), but basically disagree with EVERYTHING else you wrote.

(1) in three points you focus in on the flaw of an "ineffective" educational system because you are only being able to remember or use a fraction of what you are going to learn. Guess what-- education is like that. You learn to walk before you can fly. It's all about building a strong foundation. Doesn't matter whether you learn from books or patients, or if it's something you are going into or not -- you won't remember or use most of it. Most schooling is foundation for what's to come, not necessarily something that needs to be immediately or obviously applicable. If you only want to learn that which you need to use or that which you will remember or use 15 years later, go to a vocational school not a professional school. Medicine is a good example of the amount of foundation far far exceeding the learning you are going to actually use, and it makes you a better doctor because now and then the unusual pops up, and it's nice to have had, somewhere in the recesses of your mind, seen something similar. That's why many residencies require internships (prelim or transitional years) -- you need to be a good generalist to be a good specialist. ALL professions agree on this. In law school everybody learns about torts and criminal law even if they are going into business law -- you need the foundation even if you are never going to use it. And speaking as someone who had a prior career which also shifted from book learning to real life applicability -- you know NOTHING from the books no matter how detailed they are and how well you did. Real life isn't clean cut. You only actually learn usefully when you are dealing with real life situations in real time, not on paper. Experience beats book learning every time. Especially so in the current physician environment where the field has moved significantly from a science to a service profession. You have to be comfortable working with people, not just know you sh%$. That should be evident from the way med schools are structured, with some of the greatest weight being put on the rotations and the least on the basic science grades. It's important background/foundation, but that's all. Just like the prereqs you took to get into med school were background/foundation for the basic science years. Med school builds on this, but it isn't the knowledge itself. In a service industry the real learning is from working with people.

Look at it as a construction project. The book learning is the tools, but you don't know how to build a building by knowing how to use the tools -- you learn it by actually building a building. such is the case with a people oriented service job (as medicine is). You only learn the important stuff when you have real people in the mix.

You are frustrated because up until rotations, you were comfortable learning from books. That is how we give people foundation in our educational system. But guess what -- that's all it is. You only get good at a job -- any job, not just medicine -- when you graduate beyond the books to real life application. Med schools didn't make this up -- it's true in every career. In law firms folks right out of law school are given pretty pithy research type projects and memos to cut their teeth on and little by little they are taught to interface with clients and other counsel because they are starting out with background but lack the skills necessary for the job. So too in business paths, where folks may work their way up from researcher/analyst to a job with client interfacing. That's because you come out of school with book learning, but no people skills or applicable useful knowledge to apply to a service field. In medicine it's the same thing.

(2) I also agree with rachmoninov that MOST people remember things they've seen in real life better and longer than things they've read. that's a big reason rotations are so important -- you only get so much out of reading and it's very superficial. Until you see it in real life it doesn't stick. And most of real life is going to deviate from the classic cases you read about in books. If you expected all of life to be the black letter classic set of symptoms, you would probably only diagnose 10% of any ailment, regardless of what it was.

(3) Calls -- I actually had very good learning experiences on calls. That was the time that residents were most willing to let students actually "do" things. Suturing, LPs, etc. And I would hate for my first call experience to be in my first week of residency -- that is going to be a stressful enough time without worrying how my body will handle the overnight work etc. So we just disagree on this one.

(4) As for you becoming jaded and more and more of a "jerk", I think that's something more under your own control than you are willing to admit. Most people make it through med school a bit less idealistic but not substantially less caring. You have to look inside yourself and decide why you are taking this position. Sure you get to see the worst of humanity, particularly in the drug seeking population. But at least some of your patients are simply hard working folks from good caring families who have health issues. Remind yourself why you are going into this.

 

[Sureshot83]

I feel like my maximum medical "book" knowledge was right after I took my Step 1. I don't think I really learned all that much book knowledge in 3rd year, except for maybe some Ob/Gyn and a little bit of Peds, both of which are going to be pretty useless for the residency I am doing.

However, looking back as I'm about to graduate, I don't think 3rd year was a waste at all. I think you need it just so you can have a basic idea how things in the hospital work, how to get work done efficiently, and how diseases actually present. It is a lot different to read a vignette that tells you all the patient's symptoms, than to start seeing someone with a totally blank H&P form and putting it all together from the ground up, and deciding each step of the management, etc. It's easier to pick out the "first step in management" from a set of 5 choices on an exam, but harder when you don't have the choices in front of you and have to get every single admission order correct or else incur the wrath of the attending.

If you didn't at least learn the basics of this in 3rd year, you would be totally lost when you had the responsibility as an intern, and this would create huge inefficiency in the system. Just think back to your first day of third year, and how clueless you were about the hospital environment, what to do, etc. Now imagine feeling that way on your first day of internship. It's already stressful enough to start residency and actually have some real responsibility without the safety net that comes with being a med student, and it would be even worse if there was no 3rd year clinical rotations.


I will also add into this that I think 4th year is largely a waste of time, since absolutely no one cares anymore, and no one bothers to read up on any rotations (especially after ERAS is submitted). It basically serves three purposes:
1) By delaying the interview process until November-January, it allows for your final 3rd year grades, LoRs, and ERAS to get put together.
2) Gives you some time off to interview for residency rather than missing days of 3rd year when the grades matter
3) Gives you one last vacation before the 3-7 years of crappiness that is about to follow

 

[Doctor Bagel]

So agree, but slacking makes 3rd year easier. I'm on surgery now, which I have no interest in (I'm going into psych and don't like anatomy or procedures much to begin with). I told myself it would be useful to learn about medical and psychiatric complications following surgery, but our team expects us to scrub in to cases all day where we get to do the oh so exciting tasks of cutting sutures and staring at the back of the surgeon by you who's blocking your view. The only people who need to know surgical technique and anatomy is excruciatingly boring detail are surgeons (and maybe radiologists and pathologists for the anatomy). But we're expected to be excited by all this stuff to basically placate the egos of the attendings and residents.

But here's where the slacking comes in. I scrub in to one to two cases a day and have spent most of the rest of my time reading, which is giving me the opportunity to actually learn what I want from this rotation. If you're not super worried about your grade, you don't have to kill yourself making other people happy. Of course, it took me until the end of 3rd year before I realized this stuff.

 

[midn]

Guys, he just sounds exhausted from third year. No need to over analyze his post. He's just venting.

 

[BOOURNS]

1. If you just give me a book and tell me to R&M (read and memorize) instead of staying in the hospital, I can learn the exactly same knowledge of three rotations in the time of one

Wow, I feel bad for you. Your medical school must be really terrible if that is true.

2. "No matter what specialty you go into you need to know ____" is the biggest bullsh*t delivered to med student. A pathologist does not need to know delivering babies. Trying to make a connection between any two fields in medicine is abusing the creative mind of human being and unethical.

The idea is EXPOSURE. Do you really think you can do what an obstetrician does? Not everyone knows what they want to do when they enter third year. And anyway, having a little perspective on other fields isn't a bad thing.

3. I can't say "you learn from your patient" is wrong. But 99% of the patients I've seen offer nothing more than a vignette in some textbook.

Once again, your school/clinical opportunites must suck.

4 Our education system is so ineffective because we use perhaps 1% of what we've been taught since childhood. It is okay before med school because at least it contributes to "intellectual enlightment" (or does it). When I'm 27 and 2 years from doing what I need to do for life (residency), I demand to "show me the where the beef is."

I definitely have felt the same way on a number of occasion.

5. We all know grading is subjective, so that's no news. What's even worse is that I've been transformed from a knowledge-hungry med student to a emotion-sensitive business-like ass-sucking hypocrit. It's all about whether they like you. If my intern likes a particular TV show, I will watch that TV show instead of studying. And that has served me pretty well.

And you're blaming who/what for this behavior of yours?

6. I'm actually becoming more and more like a jerk.

We noticed.

7. Calls are pointless. Tell me what you can learn from calls ONLY. They serve these purposes 1) making the hospital look more manned than it really is 2) making the residents feel better because they have co-surferers 3) tiring you out so you know what residency is like. Well I know residency suck like bloody ****, and if I have to go thru that crap anyway in 2 years, why let me go thru it now when I don't have to?

Once again, see my responses to #1 and #3.

8. I actually support shelf exams. Without them 3rd year will be a complete waste of time. However, I really wish the clinical time helps it. It doesn't. The extreme case is surgery. 6 operations a day + 50 pimp questions won't get me a single point on the shelf because it's all medicine and surgeons ignore medicines (they never carry stethoscopes).

You have to carry a stethoscope to think about medicine? That's news to me.

9. Trying to look enthuistic while you absolutely don't give a f*ck about what they are doing is the most hypocritical thing I've ever done in my life. Watching another person writing a note and looking like "OMG I JUST LEARN HOW TO WRITE A NOTE THANK YOU!!!" is so superficial but everyone is doing.

Don't blame the system for your own flaws.

10. 9 out of 10 things you did in third year will be no more than "I did blah blah in my blah blah rotation" 15 years later. 9 out of things you've learned from studying will not retain 15 years later. 9 out of 10 comments you received on your eval won't help you become a better person, because jerks will stay jerks; it's genetic.

Probably true, but the 1/10 that sticks can make a big difference in the doctor you become. (in a good way)

END: If this sounds like a pathetic venting thread, it perhaps is.

It is. I hope you feel better.

Is third-year of med school really the best way to deliver medical education for everyone?

Probably not, but it's what we have and it works OK.

 

[xanthomondo]

1. If you just give me a book and tell me to R&M (read and memorize) instead of staying in the hospital, I can learn the exactly same knowledge of three rotations in the time of one


3. I can't say "you learn from your patient" is wrong. But 99% of the patients I've seen offer nothing more than a vignette in some textbook.

I feel like its kind of like sex: you can watch hundreds and hundreds of pornos, but when you finally step up to the plate for the first time you're going to absolutely suck in bed. Reading about it/just watching someone else doing it doesn't come even close to doing it yourself.

 

[OncoCaP]

...Is third-year of med school really the best way to deliver medical education for everyone?
[/B]

No.

Do you or the rest of us have a choice about clinical rotations? Not much (some scheduling flexibility exists for us)

Thus, we drink the Kool Aid. Cheers! If you have a better way to deliver medical education, I hope you roll it out soon. Until then, we'll need to work with what someone else thinks is the best way to teach medical students.

 

[jackbauer]

Nothing is more annoying when people complain about little grammer errors. If you can understand what someone is saying then it doesnt matter. Everyone makes grammer mistakes.

Actually... spelling and grammar mistakes are way more annoying than the complaints. It's not difficult to fix the errors, or avoid them in the first place; it goes to show the carelessness of the author. Would you randomly drop words from a sentence when talking to another human? If not, then I fail to see why it is an acceptable practice in any other form of communication.

 

[Tiger26]

third year just sucks--it's too bad too because they hold it up like a carrot to all the M2's studying for boards

 

[ACSurgeon]

third year just sucks--it's too bad too because they hold it up like a carrot to all the M2's studying for boards

Well, thanks for taking away our carrot! 😉

I think it's nice to have something to look forward to. Regardless of what the reality of that thing is. It keeps you going!

 

[sunshinedoc]

I have to agree that third year is not as amazing as they make it up to be. At least in the first two years, you are in control of your grades. But in third year, you are at the mercy of attendings, many of which could care less that you are there. You will work really hard, have no control of your schedule, study like crazy and your grade will hinge on a subjective evaluation. So, look forward to it if you want, but you will quickly realize that it is just another crappy year that you have to get through.

 

[BrickHouseMD]

sunshine my @ss. You people are depressing.

 

[MegaProjectile]

Without 3 year rotations and intern year, what make us different from optometrists, podiatrists etc. Should we call them physicians too since their training was focused mostly on one bodily area from the get go?

 

[BOOURNS]

I have to agree that third year is not as amazing as they make it up to be. At least in the first two years, you are in control of your grades. But in third year, you are at the mercy of attendings, many of which could care less that you are there. You will work really hard, have no control of your schedule, study like crazy and your grade will hinge on a subjective evaluation. So, look forward to it if you want, but you will quickly realize that it is just another crappy year that you have to get through.

Based on your criteria, I hope that you are prepared for a lifetime of crappy years.

X2 on brickhouse's comment.

 

[sunshinedoc]

If they are paying me . . . it will be slightly less crappy

 

[BOOURNS]

If they are paying me . . . it will be slightly less crappy

Maybe you picked the wrong career?

Plenty of other ways to make a living that are less "crappy" by your definition.

 

[DrJosephKim]

The 3rd year can be very draining. Make sure you find a strong social support network. Many students suffer from depression and even do some crazy things. I remember people having panic attacks during their 3rd year. Don't isolate yourself.

 

[Amoeba]

I do, honestly, understand what the OP is saying; I'd be lying if I said I hadn't thought many of the same things during third year. But he's still wrong. The way that you know, without a doubt, that third year is worthwhile and you truly have learned and grown during the year is when you start your fourth year sub-i or some other rotations with fresh third years around who are just starting out -- you get to see just how clueless they are, and remember that you had the exact same questions and were just as lost a few short months ago. If you are paying literally any attention at all third year, you really do learn a lot whether you like it or not -- you jsut can't help to. And as I said -- during the process I felt many of the same things as those expressed in the original post. The one thing I do and have always specifically disagree with of your comments is your complete disinterest in learning the basic material of specialties different than your own. I do think there are some things that all doctors should know/should have seen.

 

[IHeartNerds]

Where do all you people go? Why is third year so miserable? Why on EARTH do you dislike rotations for not preparing you for the Shelf exam, when in reality the Shelf exam has nothing to do with real clinical medicine?

I feel like I'm living in some happy bubble here. Third year (well, second half of 2nd year and first half of 3rd year for us) is amazing. I love this stuff, even being on service 15+ hours a day. I can't help but feel that if you'd rather sit and memorize a lot of books to do well on the Shelf, that you went into the wrong profession. 😕

Hahahaha, students that are on call barely do ANYTHING.

Last time I was on call (ob/gyn), I wrote six full H&Ps, induced a lady, triaged two people for ROL, caught five vag-delivery babies and repaired all their lacs (all solo), wrote all those delivery notes, and first-assisted a c-section. And watched part of an NBA playoff game. How is that not doing anything? There wasn't really anything else on service TO be doing.

 

[Ed Bob]

Where do all you people go? Why is third year so miserable? Why on EARTH do you dislike rotations for not preparing you for the Shelf exam, when in reality the Shelf exam has nothing to do with real clinical medicine?

I feel like I'm living in some happy bubble here. Third year (well, second half of 2nd year and first half of 3rd year for us) is amazing. I love this stuff, even being on service 15+ hours a day. I can't help but feel that if you'd rather sit and memorize a lot of books to do well on the Shelf, that you went into the wrong profession. 😕

Last time I was on call (ob/gyn), I wrote six full H&Ps, induced a lady, triaged two people for ROL, caught five vag-delivery babies and repaired all their lacs (all solo), wrote all those delivery notes, and first-assisted a c-section. And watched part of an NBA playoff game. How is that not doing anything? There wasn't really anything else on service TO be doing.

Thats weak stuff... when I do vag-deliveries the women never ever have lacs (all solo and I don't even allow the intern in the room)

 

[synapse lapse]

I feel like my maximum medical "book" knowledge was right after I took my Step 1. I don't think I really learned all that much book knowledge in 3rd year, except for maybe some Ob/Gyn and a little bit of Peds, both of which are going to be pretty useless for the residency I am doing.

However, looking back as I'm about to graduate, I don't think 3rd year was a waste at all. I think you need it just so you can have a basic idea how things in the hospital work, how to get work done efficiently, and how diseases actually present. It is a lot different to read a vignette that tells you all the patient's symptoms, than to start seeing someone with a totally blank H&P form and putting it all together from the ground up, and deciding each step of the management, etc. It's easier to pick out the "first step in management" from a set of 5 choices on an exam, but harder when you don't have the choices in front of you and have to get every single admission order correct or else incur the wrath of the attending.

If you didn't at least learn the basics of this in 3rd year, you would be totally lost when you had the responsibility as an intern, and this would create huge inefficiency in the system. Just think back to your first day of third year, and how clueless you were about the hospital environment, what to do, etc. Now imagine feeling that way on your first day of internship. It's already stressful enough to start residency and actually have some real responsibility without the safety net that comes with being a med student, and it would be even worse if there was no 3rd year clinical rotations.


I will also add into this that I think 4th year is largely a waste of time, since absolutely no one cares anymore, and no one bothers to read up on any rotations (especially after ERAS is submitted). It basically serves three purposes:
1) By delaying the interview process until November-January, it allows for your final 3rd year grades, LoRs, and ERAS to get put together.
2) Gives you some time off to interview for residency rather than missing days of 3rd year when the grades matter
3) Gives you one last vacation before the 3-7 years of crappiness that is about to follow

Yep, this post sums it up. Medicine is about more than book knowledge. The practice of clinical medicine is much more intricate, and often times different from what we learn "in the books." Additionally, I couldn't imagine starting intern year without knowledge of how the hospital works. Clinical acumen comes from seeing actual patients and flying by the seat of your pants, not from reading books. I know many smart students and residents who know a lot of medicine, but aren't always the best clinicians. This is of course a subjective opinion and difficult to qualify. Also, 3rd year serves to help people determine what field they should enter. In the end all of life really is composed of hoops to jump through, and this is one more, though it does serve its purpose. I have enjoyed 3rd year, much more than the first 2 years. I didn't go into medicine to read science books, I came to learn about disease and diagnose/treat people.

 

[DwyaneWade]

The OP may have been over the top on some issues, but for the most part he summarized how most students perceive third year by the end...

 

[ThinkTooMuch]

you're never going to learn to "connect the dots" when trying to treat a sick patient without extensive clinical exposure.

 

[45408]

2. "No matter what specialty you go into you need to know ____" is the biggest bullsh*t delivered to med student. A pathologist does not need to know delivering babies. Trying to make a connection between any two fields in medicine is abusing the creative mind of human being and unethical.

You're not in pathology school. You're in medical school, and you'll graduate as a physician.

3. I can't say "you learn from your patient" is wrong. But 99% of the patients I've seen offer nothing more than a vignette in some textbook.

And I learn the opposite way. I could read a billion vignettes and not remember as much as just a few of the patient encounters that I've had.

5. We all know grading is subjective, so that's no news. What's even worse is that I've been transformed from a knowledge-hungry med student to a emotion-sensitive business-like ass-sucking hypocrit. It's all about whether they like you. If my intern likes a particular TV show, I will watch that TV show instead of studying. And that has served me pretty well.

I recommend you kiss a lot less ass. It's really not necessary.

7. Calls are pointless. Tell me what you can learn from calls ONLY. They serve these purposes 1) making the hospital look more manned than it really is 2) making the residents feel better because they have co-surferers 3) tiring you out so you know what residency is like. Well I know residency suck like bloody ****, and if I have to go thru that crap anyway in 2 years, why let me go thru it now when I don't have to?

Babies and trauma. Those two rotations would have been pretty worthless without overnight call. Thankfully, no other rotation had overnight call.

9. Trying to look enthuistic while you absolutely don't give a f*ck about what they are doing is the most hypocritical thing I've ever done in my life. Watching another person writing a note and looking like "OMG I JUST LEARN HOW TO WRITE A NOTE THANK YOU!!!" is so superficial but everyone is doing.

Agreed. Especially when someone has already explained this same thing to me three times this month, but I'll look like an ungrateful jerk if I just say "Oh, I already know this. You can stop your teaching moment right now."

 

[mTOR]

Thats weak stuff... when I do vag-deliveries the women never ever have lacs (all solo and I don't even allow the intern in the room)

 

[Mr hawkings]

I wonder how the OP feels now a year later and he/she has proabably matched.

 

[juiceman311]

Weird, I disagree with your point except your point about call...that really is worthless. Sounds like medicine is not for you. 3rd year>>>>>>>>>>>>>>>>1st and 2nd year and it's not even a comparison.